FAQ

Multiple myeloma is a cancer of the bone marrow plasma cells (also referred to as plasma cell myeloma). Plasma cells make antibodies against infectious agents such as viruses and bacteria. A cancer cell or malignant plasma cell is called a myeloma cell. Myeloma is called “multiple” because there are frequently multiple patches or areas in bone marrow where it grows. 
 
Myeloma can appear as both a tumor and/or as an area of bone loss (called a lesion, with areas of bone loss caused by myeloma referred to as “lytic lesions”). The only time that myeloma is not “multiple” are in rare cases of a solitary plasmacytoma of bone (SPB) or an extramedullary plasmacytoma (EMP).  
 
While multiple myeloma is currently incurable, it is treatable. With advances in therapies, many patients are able to achieve remission and manage their disease for extended periods. Early diagnosis and treatment by a myeloma specialist are recommended for the best outcomes. LEARN MORE. 

• Multiple myeloma affects the places where bone marrow is active in an adult. Most common sites include the bones of the spine, skull, pelvis, rib cage, and the areas around the shoulders and hips. 
• Cancerous myeloma cells can also cause bone breakdown, prevent new bone cell production, increase the risk of fractures, and release calcium into the blood (hypercalcemia).  
• Myeloma in the bone marrow disrupts the production of new blood cells, causing patients to develop any of the following: low red blood cell count (anemia), low white blood cell count (neutropenia), or low platelet count (thrombocytopenia).  
• Kidney disease is a serious complication that occurs in 20-25 percent of newly diagnosed patients; up to 50 percent of patients with active myeloma may also develop kidney disease. This is due to the toxic effects of myeloma cell-derived monoclonal proteins, hypercalcemia, or infection. 
• Myeloma suppresses the immune response and reduces the number of normal antibodies (immunoglobulins).  
   

In 70% of patients, the most common symptoms of multiple myeloma are: 

• Back or bone pain 
• Fatigue 
• Recurrent or persistent infections 

Other possible symptoms include: 

• Persistent or worsening tiredness 
• Recurrent unexplained infections (such as pneumonia, sinus infection, or urinary tract infection) 
• Swelling of the extremities 
• Shortness of breath 

If you are experiencing any of these symptoms, it is important to consult your physician. 

The exact cause of multiple myeloma is unknown, but several potential risk factors have been identified: 

• Exposure to toxic chemicals like benzene, dioxins, agricultural chemicals, solvents, fuels, and engine exhaust 
• Radiation exposure 
• Immune system problems or infections that affect the immune system 
• Certain viruses like HIV, hepatitis, and herpes viruses may act as triggers 
• Family history - around 5-7% of cases occur in those with a close relative who had myeloma or a precursor condition like MGUS 

Research is ongoing to better understand the genetic and environmental factors that may contribute to the development of myeloma. Some studies are investigating if dietary and lifestyle factors play a role, especially in the progression from precursor conditions like MGUS to active myeloma. 

A multiple myeloma prognosis is determined by both the number and specific properties of myeloma cells in a given patient which include: 

• Growth rate of myeloma cells 
• Production rate of monoclonal antibody proteins 
• Production or non-production of various cytokines (molecules that allow immune cells to talk to each other) and chemicals that damage or significantly impair other tissues, organs, or bodily functions 
   

Multiple myeloma has different types and subtypes based on the immunoglobulin (protein) produced by the myeloma cell: 

• The five types of heavy protein chains are G, A, D, E, and M. 
• The two types of light protein chains are kappa (κ) and lambda (λ). 

Furthermore, there are different subtypes of myeloma. Find out more about the types of myeloma. 

1. Monoclonal gammopathy of undetermined significance (MGUS) - The earliest precursor and disease state associated with the subsequent development of myeloma, with a low level of abnormal plasma cells and monoclonal protein (or M protein) found in the blood. There are several types of MGUS, multiple myeloma may develop from plasma cell type MGUS (comprising 85 percent of all MGUS cases). MGUS occurs in 3-5 percent of the U.S. population, with higher rates among those aged 50 and older. Progression from MGUS to active myeloma occurs at a low rate of 1 percent per year. MGUS is a benign condition and patients do not need to undergo treatment unless they choose to take part in a clinical trial. However, a hematologist should monitor patients with MGUS. LEARN MORE. 
2. Smoldering multiple myeloma (SMM) - An asymptomatic precursor state of active myeloma, similar to MGUS but at an intermediate level. SMM patients have higher levels of monoclonal protein and abnormal plasma cells than MGUS, but no indications of end-organ damage based on the CRAB criteria. The average risk progression from SMM to active myeloma is 10 percent per year. SMM patients should be observed by a hematologist-oncologist at regular intervals. LEARN MORE. 
3. Active multiple myeloma – Also known as symptomatic myeloma, active multiple myeloma is diagnosed when specific tests indicate the presence of end-organ damage (based on the CRAB criteria), which may include hypercalcemia, anemia, bone lesions, and/or kidney damage. A patient experiencing 10 percent or more clonal plasma cells in the bone marrow and at least one myeloma-defining event (MDE) is diagnosed with active myeloma. LEARN MORE. 

The progression from MGUS to SMM to active myeloma involves increasing levels of abnormal plasma cells and monoclonal protein production. Careful monitoring and timely intervention are crucial to manage the disease course. LEARN MORE. 

There are two main staging systems for multiple myeloma: 

Durie-Salmon Staging System 
This system demonstrates the correlation between the amount of myeloma and the damage it has caused, such as bone disease or anemia. It has three stages: 

Stage I: Relatively low levels of myeloma cells 
Stage II: Intermediate levels 
Stage III: High levels with advanced disease 

Learn more about the Durie-Salmon Staging System. 

International Staging System (ISS) 
Developed by the International Myeloma Working Group (IMWG) in 2005, the International Staging System (ISS) is based on prognostic factors and predictors of survival which include Serum β2 microglobulin (Sβ2M), serum albumin, platelet count, serum creatinine, and age.  

The ISS has three stages: 

Stage I: Serum β2-microglobulin < 3.5 mg/L, serum albumin ≥ 3.5 g/dL  
Stage II: Serum β2-microglobulin < 3.5 mg/L; serum albumin < 3.5 g/dL; or β2M 3.5 to 5.5 mg/L, irrespective of serum albumin 
Stage III: Serum β2-microglobulin ≥ 5.5 mg/L 

Revised International Staging System (R-ISS) 
Published by the IMWG in August 2015, the Revised International Staging System (R-ISS) incorporated two further prognostic factors: genetic risk as assessed by fluorescence in-situ hybridization (FiSH) and level of lactate dehydrogenase level (LDH) to refine risk stratification. 

Staging helps guide treatment planning and determine prognosis. However, multiple myeloma is a heterogeneous disease, so other factors like cytogenetics and patient fitness also impact treatment decisions. 

Learn more about the ISS and R-ISS staging systems. 

Certain factors may increase a person's risk of developing multiple myeloma which include: 

• Age: Multiple myeloma is most commonly diagnosed in older adults between the ages of 65-74. 
• Gender: Men are 1.5 times more likely to develop multiple myeloma than women. 
• Race: African Americans have a higher risk of developing multiple myeloma compared to other racial or ethnic groups. FIND OUT WHY. 
• Family History: Having a first-degree relative (parent, sibling, or child) with multiple myeloma or a related plasma cell disorder may increase one's risk. 
• Monoclonal Gammopathy of Undetermined Significance (MGUS): MGUS is a condition characterized by the presence of an abnormal protein in the blood but without the symptoms or complications of multiple myeloma. Over time, those with MGUS have a higher risk of progressing to multiple myeloma. 
• Individuals with Plasma Cell Diseases: Plasma cell diseases such as solitary plasmacytomas increase the risk of developing multiple myeloma. 
• Exposure to Radiation or Toxic Chemicals: Prolonged exposure to radiation or toxic chemicals (such as benzene, dioxins, pesticides, solvents, fuels, and engine exhaust) may increase the risk of developing multiple myeloma. 
• Obesity: Some evidence suggests that obesity may be associated with an increased risk of multiple myeloma. 

It is important to note that while these factors may increase the risk of developing multiple myeloma, not everyone with these risk factors will develop the disease. Additionally, individuals without these risk factors may still be diagnosed with multiple myeloma.  

The exact cause of multiple myeloma is not fully understood. Additional research is ongoing to better understand the underlying factors contributing to the development of this disease. 

Multiple myeloma is the second most common blood cancer in the world. According to the National Cancer Institute (NCI) SEER data, an estimated 35,780 new multiple myeloma cases will be diagnosed in the U.S. in 2024, with myeloma representing 1.8% of all new U.S. cancer cases. 

As of 2021, an estimated 179,063 people were living with myeloma in the U.S. (NCI SEER data). 

Multiple myeloma is typically diagnosed using a combination of the following: medical history assessment, physical examination, laboratory tests, imaging studies, and sometimes bone marrow biopsy. 

Medical History and Physical Examination 
Symptoms, medical history, and family history of cancer will be assessed, and a physical examination may be performed to check for signs of multiple myeloma or related complications. 

Tests to Assess Blood Cells 
Complete blood count (CBC) to identify the presence of MGUS, SMM, or multiple myeloma. A CBC also measures red blood cells (RBC); hemoglobin (hgb); hematocrit (hct); white blood cellls (WBC); neutrophils; and platelets. LEARN MORE. 

Additionally, a simple blood test called mass spectrometry is conducted to detect and measure the precise amount of M-protein in the blood. Mass spectrometry is helpful in diagnosing and monitoring MGUS, SMM, and active myeloma. However, mass spectrometry has not yet been approved by the FDA and is only being currently conducted at a few reference laboratories. LEARN MORE. 

Tests to Assess Kidney Function 
The International Myeloma Working Group (IMWG) and National Comprehensive Cancer Network (NCCN) recommend kidney function tests for diagnosis and management of multiple myeloma, which include: 

• serum creatinine 
• estimated glomerular filtration rate (eGFR) 
• electrolyte measurements 
• free light chain assessment 
• urine electrophoresis (UPEP) of a sample from a 24-hour urine collection 

Find out why kidney tests are necessary in diagnosing and monitoring myeloma patients. LEARN MORE. 

Tests to Assess Monoclonal Protein 
This important group of blood and urine tests is used to assess the amount and activity of myeloma. These tests measure the monoclonal protein that myeloma cells secrete into the blood and/or urine. 

These blood and urine tests include Serum Quantitative Immunoglobulins (QIg), Serum Protein Electrophoresis (SPEP), Urine Protein Electrophoresis (UPEP),  Freelite® (serum free light chain assay), and Hevylite® (serum heavy + light chain isotype assay). 

Find out more about testing for monoclonal protein assessment. LEARN MORE. 

Bone Marrow Testing 
Bone marrow tests (aspirate and biopsy) are performed routinely to diagnose multiple myeloma and are also used for monitoring during treatment.  

Bone marrow aspiration makes use of a needle to collect a sample of fluid and cells from the bone marrow for examination under a microscope. 

Bone marrow biopsy involves using a hollow-bore needle to collect a sample of tissue from the bone. If cancerous plasma cells are found, the pathologist estimates how much of the bone marrow is affected.  

Know more about bone marrow testing and why they need to be performed. LEARN MORE. 

Imaging Tests 
Because bone disease is a common symptom of multiple myeloma (with 70-80 percent of patients found to have bone disease at diagnosis), imaging tests are crucial in assessing the status of a patient’s bones and/or bone marrow at diagnosis and relapse, and include: 

• X-rays 
• CT or CAT (Computerized Axial Tomography) scans 
• MRI (Magnetic Resonance Imaging) scans 
• PET (Positron Emission Tomography) scans 
• PET/CT scans 
• Bone Density Testing 

Early diagnosis is important to guide appropriate treatment planning. LEARN MORE.

The International Myeloma Working Group (IMWG) provides criteria for diagnosing myeloma based on these test results.

If you are newly diagnosed with myeloma, here are some key things to know: 

• Read the IMF's Patient Handbook for the Newly Diagnosed to better understand this complex disease, its causes, diagnostic criteria, staging, types, effects, treatment options, and supportive care measures.
• Learn about your specific type and stage of myeloma, as this will guide your treatment plan. Ask your doctor to explain the details of your diagnosis. 
• Discuss all available treatment options with your doctor, including potential side effects and how they may impact your daily life. Don't hesitate to get a second opinion. 
• Be communicative with the members of your care team: your hematologist-oncologist/myeloma specialist; primary care physician or family doctor; nurse/nurse practitioner; orthopedic surgeon/bone specialist; pharmacist; nephrologist; and dentist/oral surgeon.
• Consider if an autologous stem cell transplant could be part of your treatment strategy. Read the IMF's Understanding Stem Cell Transplant in Myeloma booklet. 
• Take an active role in your care by tracking test results over time and bringing up any new or worsening symptoms with your doctor promptly. 
• Seek support services like counseling or local myeloma support groups to help cope with the emotional impacts. 
• Stay informed by attending IMF seminars, webinars, and reading trusted myeloma publications to learn about the latest treatments and research. 

The key is to be an engaged, informed patient while maintaining a hopeful outlook. The IMF is here to provide free educational resources every step of the way. 

For further info on newly diagnosed multiple myeloma, LEARN MORE. 
 

Multiple myeloma can affect bones, red blood cells, kidneys, as well as a patient’s immune response which may lead to chronic, sometimes even severe infections. 

There are also possible urgent medical problems that may arise at diagnosis which require medical attention before systemic therapy for myeloma begins. Some of these urgent medical problems may include: 

• Vertebral compression fractures 
• Myeloma tumors (plasmacytomas) that can press on the spinal nerves 
• Nerve damage in the spinal cord 
• Infections 
• Hypercalcemia (high calcium levels in the blood) from bone breakdown 
• Kidney failure (due to high levels of calcium and monoclonal protein in the blood) 

Other possible medical problems may also include: 

• Anemia due to myeloma cells interfering with red blood cell production 
• Peripheral neuropathy (numbness, tingling, or pain in hands and feet) 
• Blood clots or venous thromboembolism 

Myeloma and its treatments can impact various organs and systems in the body. Know more about the effects of multiple myeloma within and outside the bone marrow. LEARN MORE. 

IMF Chief Scientific Officer Dr. Brian G.M. Durie talks about the “worst of the worst additives” you should avoid in his blog, You Are What You Don’t Eat. 

The Hazardous Five includes five key additives that are considered the “worst of the worst.” Avoid foods that contain these additives at all costs: Red Dye #3, Titanium Dioxide, Brominated Vegetable Oil, Potassium Bromate, and Propyl Paraben.  

Your attending myeloma clinician may recommend a consultation with a physical or occupational therapist to assess your physical activity level and needs for assistance. 

Common questions to discuss with your healthcare providers when considering your physical activity level include:  

• How do you move in and out of bed?  
• How long can you tolerate exercise, e.g., can you comfortably ride a stationary bike for 10 minutes?  
• Are you experiencing any pain in certain parts of your body? 

For healthcare providers, an exercise prescription should consist of the four components of the FITT Principle:  

Frequency: The number of sessions per week  
Intensity: How hard the person is exercising  
Time: The duration of the exercise session  
Type: The activity mode 

Before starting any exercise program, healthcare providers should assess a patient's overall fitness and safety level to engage in such exercise.  

Patients should also be educated about when to modify or abstain from their exercise regimens. As always, discuss your planned physical activities with your healthcare provider. LEARN MORE. 

The IMF is dedicated to finding a cure for myeloma and preventing its onset through various research initiatives: 

The International Myeloma Working Group (IMWG) is comprised of nearly 300 leading myeloma experts conducting collaborative research to improve patient outcomes and provide treatment guidelines followed worldwide.

The Black Swan Research Initiative (BSRI) is the IMF's signature project bridging the gap from long-term remission to an actual cure. The BSRI aims to develop the first definitive cure for myeloma. 

The annual Brian D. Novis Research Grant Program supports promising research projects by junior and senior investigators working towards better treatments and a cure. 

The Nurse Leadership Board develops recommendations for optimal nursing care of myeloma patients as part of the cure effort.

Through these robust research programs, the IMF is making significant strides and bringing hope for improved outcomes, prevention strategies, and ultimately a cure for this disease. 

Additionally, the IMF promotes health equity worldwide through the Global Myeloma Action Network, and M-Power Initiative, which aim to reduce healthcare disparities that can contribute to myeloma development in underrepresented communities. 

The IMF can help you in many ways after a myeloma diagnosis: 

• Provide free educational resources like the IMF Patient Handbook for the Newly Diagnosed to help you understand this complex disease, treatment options, and supportive care measures.
• Connect you with the IMF InfoLine staffed by trained specialists who can answer your myeloma-related questions and concerns in a caring and compassionate manner. 
• Offer opportunities to attend IMF Patient & Family Seminars or Regional Community Workshops where you can learn from myeloma experts and connect with other patients.  
• Help you find a local IMF-facilitated Support Group to share experiences and receive emotional support from others on a similar journey. 
• Empower you to make informed decisions about your care by staying up to date through IMF publications, webinars, and the latest myeloma research. 

The IMF InfoLine is staffed by trained specialists who can provide information about myeloma treatment centers and specialists in your area.  

While they cannot directly refer you to a specific doctor, they can guide you on factors to consider when choosing a myeloma specialist and treatment facility.  

The InfoLine team aims to empower you with knowledge to have informed discussions with your healthcare providers. 

The InfoLine may be reached at 1-800-452-CURE (2873) in the U.S./Canada, or worldwide at 1-818-487-7455. You may also email your inquiries to [email protected]. 

The IMF utilizes corporate and foundation support to advance its mission of improving the quality of life for myeloma patients while working towards prevention and a cure.  

Corporate gifts and foundation grants provide critical seed funding to accelerate the path to a cure. This funding can expedite the discovery of innovative treatments and expand IMF programming to support those affected by this incurable disease. 

The IMF guides corporate giving strategies to align with companies' goals, target audiences, and marketing objectives.  

By partnering with the IMF, corporations make a wise investment in the future while providing value for their organization.  

Corporate and foundation funding allows the IMF to continue its vital research initiatives, educational resources, support services, and advocacy efforts for the myeloma community worldwide. 

Know more about what the IMF does in the latest IMF Impact Report and the latest IMF Annual Report. 

Unfortunately, the IMF is not able to provide direct monetary assistance to patients, but we do have information about financial resources that may be available to you.

You can view a list of co-pay assistance programs or contact the IMF InfoLine at 1-800-452-CURE (2873) in the U.S./Canada, or globally at 1-818-487-7455. Phone lines are open Monday through Friday, 9 a.m. to 4 p.m. (PST). You may also email your inquiries to [email protected].